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1. NEW EDITION OF ADOLESCENT VIOLENCE PREVENTION KNOWLEDGE PATH RELEASED

The new edition of the Adolescent Violence Prevention knowledge path is an
electronic guide on recent, high-quality resources and information tools.
Produced by the MCH Library, the knowledge path includes information on
(and links to) Web sites and electronic publications, journal articles,
databases, and electronic newsletters. It is intended for use by health
professionals, program administrators, educators, researchers, and parents
who are interested in tracking timely information on this topic. The
knowledge path is available at
http://www.mchlibrary.info/KnowledgePaths/kp_adolvio.html.

MCH Library knowledge paths on other maternal and child health topics are
available at http://www.mchlibrary.info/KnowledgePaths/index.html. The MCH
Library welcomes feedback on the usefulness and value of these knowledge
paths. A feedback form is available at
http://www.mchlibrary.info/KnowledgePaths/feedback.html.

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2. JOURNAL SUPPLEMENT ADDRESSES THE MEDICAL HOME

The supplement to the May 2004 issue of Pediatrics, titled The Medical
Home, pulls together in one location a large body of research on the cost
and quality benefits of providing a medical home -- a central source of
health care for infants, children, adolescents, young adults, and
particularly children with special health care needs that is accessible,
family centered, comprehensive, continuous, coordinated, compassionate,
and culturally effective. Articles in the supplement document the vision
of the medical home and present practical tools and methods that have
proved successful in overcoming recognized barriers to care. The
supplement also includes the American Academy of Pediatrics' 2002 policy
statement on the medical home and a list of helpful Web sites. The
supplement is intended to support pediatricians' efforts to improve their
practices, stimulate academic pediatricians to conduct research, encourage
families as they face their many daily challenges, and inform policymakers
in their efforts to make the medical home a reality for families and child
health professionals. The supplement is available to Pediatrics
subscribers at http://www.pediatrics.org.

3. STUDY EXAMINES TRENDS IN BLOOD PRESSURE AMONG CHILDREN AND ADOLESCENTS

"Systolic and diastolic blood pressure has increased substantially among
children and adolescents in the United States," state the authors of an
article published in the May 5, 2004, issue of JAMA, The Journal of the
American Medical Association. The authors compared systolic and diastolic
blood pressure levels among children and adolescents ages 8 to 17 who took
part in the National Health and Nutrition Examination Survey (NHANES)
1999-2000 with corresponding values among children and adolescents who
took part in NHANES 1988-1994. They also evaluated the relationship
between trends in children's and adolescents' body mass indexes (BMIs) and
blood pressure levels.

The current analysis was limited to children and adolescents in NHANES
1988-1994 (N=3,496) and NHANES 1999-2000 (N=2,086) with three valid
systolic and diastolic blood pressure measurements and height and weight
measurements. Two serially conducted cross-sectional studies examined
trends in systolic and diastolic blood pressure among children and
adolescents between 1988 and 2000.

The authors found that

* After adjustment for differences in age, race, and sex, children's and
adolescents' mean systolic blood pressure was 1.4 mm Hg higher and
diastolic blood pressure was 3.3 mm Hg higher in 1999-2000 than in
1988-1994.
* Significant increases in blood pressure levels were observed in all
subgroups for diastolic blood pressure and in most subgroups (non-Hispanic
blacks, Mexican Americans, boys, girls, and children and adolescents ages
8 to 12) for systolic blood pressure.
* After BMI adjustment, systolic blood pressure was 1.0 mm Hg higher among
children and adolescents ages 8 to 17 in 1999-2000 than in 1988-1994.
Diastolic blood pressure was 2.9 mm Hg higher among children and
adolescents in 1999-2000 than in 1988-1994.

"The strong association between BMI and systolic blood pressure among
children and adolescents is worrisome because the U.S. prevalence of
overweight has been increasing over the past several decades," conclude
the authors. They add that "effective primary and secondary hypertension
prevention programs aimed at children and adolescents that include
prevention of overweight, weight loss, increased physical activity, and
dietary modification need to be developed and implemented."

Muntner P, He J, Cutler JA, et al. 2004. Trends in blood pressure among
children and adolescents. JAMA, The Journal of the American Medical
Association 291(17):2107-2113.

"Breastfed children have a decreased risk of postneonatal death in the
United States, although infectious diseases, those most plausibly
prevented by breastfeeding, no longer contribute substantially to
postneonatal mortality," write the authors of an article published in the
May 2004 issue of Pediatrics Electronic Pages. The authors state that in
developing countries, breastfeeding protects against diarrhea and
respiratory diseases, important causes of infant death. In contemporary
developed countries, however, where infectious diseases account for a
smaller portion of infant mortality, what effect, if any, breastfeeding
has on mortality is not clear. The study described in this article used
1988 U.S. Maternal and Infant Health Survey (NMIHS) data to analyze the
association between breastfeeding and postneonatal death (between 28 days
and 1 year of life).

NMIHS is a nationally representative stratified systemic sample of 9,953
women who had live births, 3,309 women who had late fetal deaths, and
5,332 women who had infant deaths in 1988. Mothers answered a mailed
questionnaire on characteristics of the parents, previous and subsequent
pregnancies, prenatal care and health habits, and the infant's health.
Questions about whether the mother ever breastfed her infant and the
duration of breastfeeding were included.

The authors found that

* Mothers of the children who died were younger, were less educated, and
smoked more often during pregnancy.
* The children who died had a higher birth order and were more often male,
black, and of low birthweight.
* Most of the children who died did so before age 4 months.
* Overall, children who were ever breastfed had 0.79 times the risk of
dying in the postnatal period, compared with those who were never
breastfed.
* Longer breastfeeding was associated with lower risk of postneonatal death.

The authors conclude that "If all children were breastfed, then . . . 720
postneonatal deaths might be prevented or delayed each year at little cost
or risk. The benefit would be concentrated among young, less educated
mothers."

Chen A, Rogan WJ. 2004. Breastfeeding and the risk of postneonatal death
in the United States. Pediatrics Electronic Pages 113(5):e435-e439.

"Conducting this online needs assessment revealed a need for and interest
in time effective health promotion content on the part of MCH [maternal
and child health] educators from various disciplinary backgrounds across
the United States," state the authors of an article published in the June
2004 issue of the Maternal and Child Health Journal. The article describes
a study to (1) determine the needs of MCH educators in delivering health
promotion content in their professional settings, (2) identify their
skills in using various teaching strategies to deliver such content, and
(3) assess their personal learning preferences. MCH educators were defined
as professionals involved in any aspect of MCH education.

A self-administered survey instrument was developed, and a link to the
survey was distributed via e-mail to the 11 Bright Futures Health
Promotion Workgroup member sites around the country. Each site identified
one MCH educator from a variety of disciplines (medicine, nursing,
dentistry, social work, public health, and other) and asked this educator
to complete the survey. These secondary contacts were then asked to
"forward the link via e-mail to all members of their faculty involved in
any aspect of MCH education." The instrument contained questions about
respondents' (1) professional backgrounds and experiences as educators,
(2) experiences and preferences concerning continuing education, (3)
confidence in their ability to use specified teaching strategies and
desire for improvement in each area, (4) confidence in their ability to
teach six health promotion core concepts and desire for improvement in
each concept, and (5) confidence in their computer skills and ability to
use computer-based technologies.

The authors found that

* A majority of the respondents had backgrounds in nursing (41%), public
health (27%), or medicine (27%).
* Although day-long seminars or lectures were the preferred continuing
education methods, over one-third preferred Web-based study.
* A majority of the respondents agreed or strongly agreed that they were
confident in their ability to use the specified teaching strategies yet
would like to improve their ability to use the strategies.
* A majority of the respondents agreed or strongly agreed that they were
confident in their ability to teach the six health promotion concepts yet
would like to improve their ability to teach the concepts.
* Ninety-six percent of respondents agreed or strongly agreed that they
were confident in their ability to use e-mail. For other computer skills
and technologies, the percentages were as follows: word processing --
88%, using search engines -- 80%, "surfing" the Internet -- 78%, using
CD-ROMs -- 75%, uploading/downloading -- 71%, using PowerPoint -- 62%,
using chat rooms -- 21%, and using video streaming -- 15%.

"These findings have helped to inform the development of a Bright
Futures-based health promotion distance learning program Pediatrics in
Practice (www.pediatricsinpractice.org) available in paper-based and
online formats," conclude the authors.

Permission is given to forward MCH Alert to individual colleagues. For
all other uses, requests for permission to duplicate and use all or part
of the information contained in this publication should be sent to MCH
Alert Editor, National Center for Education in Maternal and Child Health,
at mchalert@ncemch.org.

The editors welcome your submissions, suggestions, and questions. Please
contact us at the address below.